Question

A 70-year-old male has excruciating pain in the lower left part of his face. This began 1 month ago. He describes it as being like a jolt of lightning that radiates from his left ear, down to his jaw, and to the side of his mouth. These jolts of pain occur numerous times each day. Between attacks his face seems normal. He denies any numbness or tingling sensations. There is no hearing abnormality. The pain is triggered by talking, chewing or touching the lower left part of his face. He is unable to eat or brush his teeth, particularly on the left side, since he fears triggering another painful attack. He can only drink his meals through a straw and cannot lie in bed on his left side. He had the same symptoms about 2 years ago. At that time he was treated with a medication, which helped; symptoms subsided, but he stopped taking the medicine. The pain is so distressing that the patient admits to contemplating suicide. The general and neurologic exam is normal, except that he withdraws and will not let anyone touch the left side of his face.

What is the diagnosis, treatment options, and explanation of your hypothesis?

Answer 1

Diagnosis:

In this case, the diagnosis is inflammation in the area of the lower left part of his face due to injury and the inflammation process is continued due to the infection occurs in that area.

Treatment:

The treatment is given with NSAID's and Antibacterials

The ibuprofen is preferred as NSAID to treat inflammation

The amoxicillin 500mg and Clavunalic acid 125mg per day are preferred to treat a bacterial infection.

Hypothesis:

The injury to the patient in the area of the lower part of the face results in inflammation in that area which causes a jolt of pain because sensory nerve innervation is more in this area. The subsequent bacterial infection made his condition worse. the bacterial infection is a reason for the pain or inflammation is not cured on its own body mechanism for one month.